Objectives/Goals: To evaluate the effectiveness of multiple grant writing support services – including workshops, one-on-one mentoring, and grant pre-review – in improving faculty success in securing research funding. Methods/Study Population: The study included junior faculty participating in the R Club Grant Program – a grant development program to assist junior faculty in the preparation of their first research grant proposal – within the University of Cincinnati College of Medicine (UC COM) and the Center for Clinical & Translational Science & Training (CCTST), as well as UC COM faculty who engaged in one-on-one mentoring, workshops, or the Grant Pre-Review Program. Data on participation, satisfaction, and grant submission outcomes were collected and analyzed to assess the impact of each grant writing support service. Results/Anticipated Results: More than 100 investigators participated in R Club Grant Program workshops and received supplemental grant development materials. Comprehensive support – including workshops, mentoring, and pre-review – has contributed to successful funding across multiple NIH mechanisms (K23, R01, R03, R21, R35, and R56). Based on positive participant feedback, future expansion will include online and on-demand resources to enhance accessibility to grant writing webinars and training materials. Discussion/Significance of Impact: Comprehensive grant writing support improves faculty preparedness and funding success. Expanding to online and on-demand formats will broaden access, promote equity in research training, and strengthen institutional grant competitiveness.

Background and Objectives:Approximately one-fourth of all strokes are recurrent, which is associated with a higher risk of morbidity/death. Identifying stroke survivors at greatest risk of recurrence could help direct secondary prevention efforts, but prior models based on clinical data have limited predictive ability. Neuroimaging markers of brain health may be uniquely able to capture the duration and severity of traditional and nontraditional risk factors for recurrence, and we examined whether they could improve the prediction of stroke recurrence beyond clinical factors alone using advanced machine-learning techniques. Methods:Using a well-validated approach, all ischemic strokes and TIAs during 2015 were ascertained in a representative population of the United States. Standard-of-care neuroimaging was collected for all patients across 18 different hospitals and centrally read/analyzed for more than 20 different measures of brain health. Only patients who underwent standard of care MRI were included. Patients were then followed for 3 years to assess for stroke recurrence. Using both clinical and neuroimaging variables, prediction models of recurrence at 90-days and 3-years were built using random survival forests. Results:A total of 1999 patients (46.6% male and 21.2% Black) had sufficient clinical and imaging data to be included in the final study population, including 275 (13.8%) patients who experienced a recurrent stroke event. Models that included clinical and imaging variables outperformed those with clinical data alone at 90 days (C-statistics increased from 0.63 with 95% CI 0.520-0.740 , to 0.667 with 95% CI 0.567-0.767; P=0.0498) and at 3 years (C-statistics increased from 0.618 with 95% CI 0.572-0.663 to 0.683 with 95% CI 0.637-0.729; P<0.001).Among imaging variables, global cortical atrophy scale, microbleed count, deep white matter hyperintensities (WMH), and baseline CT ASPECTS were highly important variables at both time points. Discussion:Neuroimaging data can improve the prediction of stroke recurrence but only moderately improves discriminative ability. Other strategies will be needed to better identify stroke patients at highest risk of recurrence, including dynamic prediction models or other non-imaging biomarkers.

NeuroGleam is a deep-learning (DL) pipeline for fully automated segmentation of white-matter hyperintensities (WMH) on single-modal, low-resolution T2-FLAIR which is one of the most common MRI series in clinical care. Our preliminary investigation involved benchmarking of six DL architectures under four loss objectives. We found HRNet and its variants to be the best performing architecture and introduced a hyper-parameterized HRNet which was tuned using Bayesian optimization. Experiments span the Medical Image Computing and Computer Assisted Intervention (MICCAI) WMH Challenge dataset, and a 69-subject in-house clinical cohort called Assessing Population-based Radiological Brain Health in Stroke Epidemiology (APRISE). Metrics include Dice, Hausdorff95, lesion-wise sensitivity/F1, and average volume difference. The best HRNet achieves Dice 0.742 (MICCAI) and 0.651 (APRISE) with Hausdorff95 6.24–7.75 mm. Cross-dataset testing drops to Dice 0.523, underscoring domain-shift limits. We discuss practical design choices and outline ongoing work including transfer learning, domain adaptation and out-of-distribution detection to close the generalization gap and enable robust deployment.

Introduction: Approximately 20% of strokes in the United States are preceded by either a stroke or transient ischemic attack (TIA). Determining which stroke patients are at higher risk for recurrence allows for individualized, aggressive secondary stroke prevention. A comprehensive clinical decision tool, considering the full spectrum of radiological brain health" including small vessel disease parameters, is currently lacking. Furthermore, large-scale characterization of pre-existing radiological brain health may elucidate novel phenotypes. This study aims (1) to characterize imaging manifestations of brain health at a population level, and associated demographic and clinical risk factors at the time of index stroke and (2) to create a 90-day and three-year prediction models of cerebrovascular disease recurrence (ischemic or hemorrhagic stroke) incorporating comprehensive parameters from routine clinical imaging. Methods: Our overall cohort was estimated to consist of 4250 patients hospitalized with stroke, including 525 with hemorrhagic and 3725 with ischemic/TIA subtypes, ascertained in the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) population of 1.4 million residents from January 1, 2015 through December 31, 2015. Among 3725 ischemic stroke/TIA patients, based on published and ongoing data collection, we estimated that approximately 16% will have a recurrent ischemic or hemorrhagic stroke over the subsequent three years. Among these, 80% were estimated to have MR imaging for review. Leveraging extensive clinical and demographic data already collected in the 2015 NIH-funded GCKNSS study, we will have obtained and centrally characterized magnetic resonance imaging (MRI), acute CT, and vascular data in patients with hospitalized stroke/TIAs. We will determine if and how pre-existing imaging parameters cluster using factor analysis, and identify associated demographic and clinical risk factors in multivariable modeling. We will develop short term (90-day) and long term (three-year) risk prediction models using the machine learning approach of random survival forest with internal validation, and perform Cox regression models as a sensitivity analysis. Conclusion: The primary outcome is recurrence defined as any stroke (ischemic or hemorrhagic) occurring after index ischemic stroke or TIA event. For index ischemic strokes, the second event must within a different vascular territory if <14 days from the index event.

BACKGROUND:Minimally invasive surgical evacuation improved outcomes for patients with acute, spontaneous, lobar intracerebral hemorrhage (ICH) in the ENRICH trial (Early Minimally Invasive Removal of ICH). We determined the percentage of patients with ICH in a US population-based study eligible for minimally invasive surgical evacuation and projected the annual number of patients with ICH in the United States in 2020 eligible for this therapy. METHODS:We ascertained adults (aged ≥18 years) with acute (<24 hours from last known well), spontaneous ICH in Greater Cincinnati/Northern Kentucky in 2015. Cases were identified by the International Classification of Diseases codes, clinical data abstracted, and physician adjudicated. Location and volume of ICH were centrally adjudicated by neuroradiologists. We applied ENRICH trial criteria to calculate conservative and liberal estimates of the percentage of patients with (1) all ICH at any location and (2) lobar ICH eligible for minimally invasive surgical evacuation. We extrapolated our estimates to the 2020 US adult population using 2020 US census data. RESULTS:We identified 196 patients in Greater Cincinnati/Northern Kentucky in 2015 with acute, spontaneous ICH. After applying all criteria, 2.0% (n=5) of all patients with acute ICH (5.1%; n=5 lobar ICH) were eligible for minimally invasive surgical evacuation. The most common exclusion criteria were ICH volume <30 mL (60%) and prestroke modified Rankin Scale score >1 (52%). In liberal estimates, 2.6% to 3.6% (n=4-7) of all patients with acute ICH (4.1%-7.1% of lobar ICH) were eligible. We projected 1066 to 1848 patients of an estimated 72 283 adult patients with ICH in the United States in 2020 met eligibility criteria. CONCLUSIONS:Approximately 2% to 4% of patients with ICH in our population were eligible for minimally invasive surgical evacuation based on ENRICH criteria, which extrapolates to 1066 to 1848 patients with ICH in the United States annually. Future research is needed to determine whether indications for effective surgical therapy for ICH can be expanded.

Background Limited data exist regarding differences in ischemic stroke care across the care continuum between patients with and without prestroke disability. We investigated differences in in‐hospital and postdischarge ischemic stroke cause evaluation and treatment between patients with and without prestroke disability using population‐based data in the United States. Methods We ascertained all adult patients (≥18 years) hospitalized with acute ischemic stroke within the Greater Cincinnati/Northern Kentucky population between January 1, 2015, and December 31, 2015. We used univariate analyses and logistic regression to compare differences in acute ischemic stroke reperfusion therapies, stroke cause evaluation, prescription of secondary stroke prevention treatments, and rehabilitation between patients with prestroke disability (modified Rankin Scale score ≥2) and those without prestroke disability (modified Rankin Scale score 0–1). Results Of 2476 ischemic stroke patients, 1326 (53%) had prestroke disability. Prestroke disability was associated with lower odds of receiving thrombolysis (adjusted odds ratio [aOR], 0.43 [95% CI, 0.28–0.68], P<0.01) and endovascular thrombectomy (aOR, 0.32 [95% CI, 0.13–0.78], P<0.01). Patients with prestroke disability were less likely to receive complete in‐hospital stroke cause evaluation (aOR, 0.48 [95% CI, 0.33–0.69], P<0.01) and there were small differences in antiplatelet (84% versus 87%) and statin therapy (80% versus 86%) prescribed at discharge. Those with prestroke disability were more likely to receive in‐hospital (aOR, 2.6 [95% CI, 2.11–3.21], P<0.01) and postdischarge rehabilitative therapies (aOR, 2.27 [95% CI, 1.86–2.77], P<0.01). Conclusion Further research into factors driving medical decision‐making for patients with prestroke disability is needed to optimize the entire spectrum of ischemic stroke care for this population.

BACKGROUND AND OBJECTIVES:Understanding the current status of and temporal trends of stroke epidemiology by age, race, and stroke subtype is critical to evaluate past prevention efforts and to plan future interventions to eliminate existing inequities. We investigated trends in stroke incidence and case fatality over a 22-year time period. METHODS:In this population-based stroke surveillance study, all cases of stroke in acute care hospitals within a 5-county population of southern Ohio/northern Kentucky in adults aged ≥20 years were ascertained during a full year every 5 years from 1993 to 2015. Temporal trends in stroke epidemiology were evaluated by age, race (Black or White), and subtype (ischemic stroke [IS], intracranial hemorrhage [ICH], or subarachnoid hemorrhage [SAH]). Stroke incidence rates per 100,000 individuals from 1993 to 2015 were calculated using US Census data and age-standardized, race-standardized, and sex-standardized as appropriate. Thirty-day case fatality rates were also reported. RESULTS:Incidence rates for stroke of any type and IS decreased in the combined population and among White individuals (any type, per 100,000, 215 [95% CI 204-226] in 1993/4 to 170 [95% CI 161-179] in 2015, p = 0.015). Among Black individuals, incidence rates for stroke of any type decreased over the study period (per 100,000, 349 [95% CI 311-386] in 1993/4 to 311 [95% CI 282-340] in 2015, p = 0.015). Incidence of ICH was stable over time in the combined population and in race-specific subgroups, and SAH decreased in the combined groups and in White adults. Incidence rates among Black adults were higher than those of White adults in all time periods, and Black:White risk ratios were highest in adults in young and middle age groups. Case fatality rates were similar by race and by time period with the exception of SAH in which 30-day case fatality rates decreased in the combined population and White adults over time. DISCUSSION:Stroke incidence is decreasing over time in both Black and White adults, an encouraging trend in the burden of cerebrovascular disease in the US population. Unfortunately, however, Black:White disparities have not decreased over a 22-year period, especially among younger and middle-aged adults, suggesting the need for more effective interventions to eliminate inequities by race.

BACKGROUND AND OBJECTIVES:Few studies have examined trends and disparities in long-term outcome after stroke in a representative US population. We used a population-based stroke study in the Greater Cincinnati Northern Kentucky region to examine trends and racial disparities in poststroke 5-year mortality. METHODS:All patients with acute ischemic strokes (AISs) and intracerebral hemorrhages (ICHs) among residents ≥20 years old were ascertained using ICD codes and physician-adjudicated using a consistent case definition during 5 periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, and 2015. Race was obtained from the medical record; only those identified as White or Black were included. Premorbid functional status was assessed using the modified Rankin Scale, with a score of 0-1 being considered "good." Mortality was assessed with the National Death Index. Trends and racial disparities for each subtype were analyzed with logistic regression. RESULTS:We identified 8,428 AIS cases (19.3% Black, 56.3% female, median age 72) and 1,501 ICH cases (23.5% Black, 54.8% female, median age 72). Among patients with AIS, 5-year mortality improved after adjustment for age, race, and sex (53% in 1993/94 to 48.3% in 2015, overall effect of study year p = 0.009). The absolute decline in 5-year mortality in patients with AIS was larger than what would be expected in the general population (5.1% vs 2.8%). Black individuals were at a higher risk of death after AIS (odds ratio [OR] 1.23, 95% CI 1.08-1.39) even after adjustment for age and sex, and this effect was consistent across study years. When premorbid functional status and comorbidities were included in the model, the primary effect of Black race was attenuated but race interacted with sex and premorbid functional status. Among male patients with a good baseline functional status, Black race remained associated with 5-year mortality (OR 1.4, 95% CI 1.1-1.7, p = 0.002). There were no changes in 5-year mortality after ICH over time (64.4% in 1993/94 to 69.2% in 2015, overall effect of study year p = 0.32). DISCUSSION:Long-term survival improved after AIS but not after ICH. Black individuals, particularly Black male patients with good premorbid function, have a higher mortality after AIS, and this disparity did not change over time.

Introduction: Prior work suggests stroke recurrence timing may vary by subtype, with large vessel disease being associated with earlier recurrence; however, these studies were conducted prior to the current era of secondary stroke prevention strategies. We examined whether the timing of recurrence after ischemic stroke varied by subtype in a large population-based study. Methods: In 2015, we identified all acute ischemic stroke events from hospitals in the Greater Cincinnati and Northern Kentucky area. Events in the last 6 months of 2014 were oversampled for black patients. Trained nurses extracted clinical data, and stroke specialists subtyped and adjudicated cases. We tracked events for 3 years, considering only ischemic strokes after day 14 as a recurrence. To assess recurrence timing variations, we stratified strokes by subtype and analyzed their restricted mean survival times (RMST) at 1, 3, 12, 24, and 36 months. RMST is the area under the survival curve up to a specific follow up point, denoting the average event-free time during that interval. Results: Of 2577 patients with index stroke, 332 recurrent strokes were seen over the ensuing 3 years. Half of the recurrences occurred within 8 months from the index event. At 12 months, large vessel (LV), undetermined, and other identified cause showed a statistically significant smaller RMST compared to small vessel (SV). This difference was nonsignificant at later time points, suggesting later recurrence for SV. There were no statistically significant differences in RMST between cardioembolic, LV, undetermined, and other identified at any time point. Conclusions: Recurrence after initial SV stroke was less likely to occur in the first year when compared to LV, undetermined etiology, or other identified causes of stroke. There was no evidence of difference in recurrence timing between cardioembolic, LV, other identified, and undetermined etiology.

Background: Prehospital stroke triage scores aim to identify LVO patients who benefit from direct transport to high-level stroke centers for EVT by bypassing primary stroke centers. Patients with ICH may benefit from direct transport to high-level centers for neurologic intensive care and hematoma evacuation. Lobar ICH patients may particularly benefit as randomized clinical trial data suggest hematoma evacuation is more effective in these patients. We determined the ability of prehospital LVO triage scores to identify ICH patients and to discriminate lobar from non-lobar ICH. Methods: We identified ICH cases presenting to the ED in Greater Cincinnati/Northern Kentucky in 2005, 2010, and 2015. Cases were identified by ICD codes (ICD9 430-438, ICD10 G45-46, H34.11-12, I60-69), clinical data was extracted by a research nurse and adjudicated by physicians. The CSTAT and RACE scores were abstracted from the NIHSS. We calculated the proportion of ICH patients with a CSTAT ≥ 2 and a RACE ≥ 5, cut-offs used to bypass primary stroke centers, and the scores’ ability to distinguish lobar from non-lobar ICH. Results: We identified 904 ICH patients (median age 72, 54% female, 25% Black). CSTAT was ≥ 2 in 45% of all ICH patients while 27% had a RACE ≥ 5. These score cut-offs identified patients with more severe deficits (Table). Among patients with lobar ICH (n=391), 44% had a CSTAT ≥ 2 and 27% had a RACE ≥ 5. Results were similar for non-lobar ICH (n=473, 45% CSTAT ≥ 2 and 26% RACE ≥ 5). Both scores performed poorly in differentiating lobar from non-lobar ICH (CSTAT ≥ 2: sensitivity 0.44, specificity 0.55, AUC 0.52; RACE ≥ 5: sensitivity 0.27, specificity 0.74, AUC 0.53). Conclusion: Prehospital LVO triage scores identified fewer than half of all ICH patients and did not discriminate between lobar and non-lobar ICH. New prehospital triage scores are needed to identify all ICH patients, or perhaps ICH subgroups, along with LVO patients who benefit from direct transport to high-level stroke centers.

Introduction: Endovascular (EVT) eligibility estimates using population-based, NIH-funded Greater Cincinnati Northern Kentucky (GCNK) Stroke Study 2010 data have been reported. Given the evolving EVT landscape, we present updated estimates of annual EVT eligibility using the 2015 GCNK epidemiological data and extrapolate to the 2021 US census. We project the potential increase in eligible patients in the US for each possible expanded indication with a randomized trial currently planned/underway. Methods: We ascertained all hospitalized AIS patients ≥18 years old in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 within GCNK population; all cases were physician-reviewed. Patients presenting within 0-5 hrs of last known well (LKW) were considered EVT eligible if they had a pre-stroke mRS<2, NIHSS ≥6 and ASPECTS ≥6. Those within 5-23 hrs of LKW were considered EVT-eligible if they had a pre-stroke mRS <3, NIHSS≥6, and favorable perfusion imaging. Expanded EVT eligible patients were defined as those with NIHSS <6, and pre-stroke mRS >1 (for 0-5 hrs) or ≥2 (for 5-23 hrs), or larger core. Estimates of vessel occlusion and favorable imaging were applied based on literature review and expert opinions. The derived estimates were age, race and sex-adjusted to the 2015 US adult population and extrapolated to 2021 population. Results: Among the 1.3 million total (1.05m adult) GCNK population in 2015, 2741 adults had an ischemic stroke and 2176 had data available for this analysis. A total of 1978 presented within 23 hrs of LKW, and 1233 within 0-5 hrs of LKW. Further results are outlined in the figure. Conclusions: It is estimated 18,484 adult patients in the US in 2021 meet strict EVT eligibility criteria. An estimated 15,699 patients with low NIHSS, 9621 with unfavorable imaging, and 28,107 with pre-stroke disability may become eligible for EVT in the future annually. US stroke systems should be optimized to handle all EVT-eligible stroke patients both now and in the future.

Background: Previous studies have shown that neighborhood socioeconomic status may be associated with post-stroke mortality. However, these studies did not adjust for stroke severity. We aim to determine the association between neighborhood of residence on long-term mortality after stroke. Methods: Within our population of 1.3 million in the Greater Cincinnati Northern Kentucky area, incident strokes among adult residents were ascertained at all area hospitals during calendar years 2005, 2010 and 2015. Participants addresses were used to geocode and determine their census tract and then used a validated index to determine neighborhood socio-economic status. We used national death index data to determine mortality status at 5 years post stroke. Individuals who survived at least 30 days were included in the analysis. We used cox proportional hazards to determine the association between neighborhood of residence deprivation and case fatality rate after stroke. Results: Among 4514 incident ischemic strokes, there were 1719 deaths over 5 years; for an all-cause post-stroke mortality rate of 38.08% among survivors of 30 days post-stroke. Similarly, there were 552 intracerebral hemorrhages with 224 deaths over 5 years: yielding an all-cause post-stroke mortality rate of 40.58%. Individuals in the quartile of neighborhoods with lowest neighborhood socio-economic status had 1.3 times the all-cause post-stroke mortality rate (HR 1.29 95% CI 1.08-1.54); after adjustment for age sex, race, and year of study (2005, 2010 and 2015). After adjustment for age, race, sex, year of study and NIH stroke scale score, individuals living in the quartile of neighborhoods with the lowest neighborhood socio-economic status had 1.29 times the risk of dying (HR 1.29 95% CI 1.09-1.53). We found insufficient evidence of an association between neighborhood socio-economic status and 5-year case fatality rate among intracerebral hemorrhages. Conclusion: Rates of all-cause post-stroke long-term mortality were higher among patients with ischemic stroke who lived in neighborhoods with lowest quartile of socio-economic status. This effect persisted even after adjusting for stroke severity.

Poverty is associated with greater stroke incidence. The relationship between poverty and stroke recurrence is less clear.

Background: Poorer socioeconomic status (SES) is associated with higher stroke incidence. Less is known about SES and stroke recurrence. We sought to obtain updated estimates of stroke incidence stratified by aggregate measures of SES, and to explore the association between SES and stroke recurrence. Methods: The Greater Cincinnati/Northern Kentucky region includes a population of 1.3 million, representative of the US population in terms of sociodemographics and percent black race. We ascertained all hospitalized strokes in the region in 2015 by screening ICD-9 codes 430-437 and ICD-10 codes I60-69, G45-46. Recurrent strokes were ascertained from 1/1/2015-12/31/2018. Patients’ home addresses were geocoded using DeGAUSS. Population estimates were obtained from the US Census Bureau using the 2015 5-year American Community Survey. Aggregate SES was estimated by percentage below poverty in each census tract. Regional incidence and recurrence rates were adjusted for age, sex, and race and calculated both with and without SES adjustment using Poisson regression models. Results: Stroke incidence and recurrence rates stratified by SES are shown in the Table. Poorer SES was associated with greater stroke incidence (p<0.01) and recurrence (p<0.01) across races. The relative risk (95% CI) for first-ever stroke among black compared with nonblack individuals was 2.06 (1.79-2.38) before adjusting for SES, and 1.79 (1.54-2.08) after adjusting for SES. The relative risk (95% CI) for recurrent stroke among black compared with nonblack individuals was 2.54 (1.91-3.37) before adjusting for SES, and 2.00 (1.47-2.74) after adjusting for SES. There was no race by SES interaction. Conclusions: Poorer SES was associated with increased risk for both incident and recurrent stroke across races. Of the excess risk for stroke incidence among black individuals, 25.5% was accounted for by SES, while 35.1% of the excess risk for recurrence was accounted for by SES.

Background: Prior studies have shown that individuals who have an in-hospital stroke are less likely to receive thrombolysis. Few studies have investigated the trends of in-hospital strokes over time, and many large databases do not include in-hospital strokes. We aimed to determine how in-hospital strokes compared to out-of-hospital stroke over time in terms of number of strokes, treatment, and 30-day mortality. Methods: Within the Greater Cincinnati Northern Kentucky area, all incident strokes among adult residents were ascertained at all hospitals during July 1993-June 94, calendar years 1999, 2005, 2010, 2015. Data for all potential cases were adjudicated by study physicians. We defined in-hospital strokes as all physician adjudicated strokes that happened when the patient had already been admitted for a condition aside from stroke. Out of hospital strokes were patients who were not admitted to the hospital when their stroke symptoms. We used national death index data to determine death at 30 days post-discharge. Results: Among 13134 strokes from 1993-2015, 1152 (9%) occurred in the hospital. The percentage of in-hospital strokes over time stayed similar (Figure 1). Overall, in-hospital strokes were more likely to be hemorrhagic in 2015 than in 1993/94; 12 % in 2015 vs. 3.6% in1993/94 (p=0.003). For both in-hospital and out-of-hospital strokes the percentage of ischemic strokes given thrombolysis increased over time (2% vs. 3% in 1993 compared to 12% vs. 10% in 2015 for in-hospital and out-of-hospital strokes respectively). 30-day mortality rate was higher for in-hospital strokes compared to out of hospital strokes throughout all study years (30.1% for in-hospital strokes and 13.4% for out of hospital strokes; p<0.001). Conclusions: We found in this population-based study that although the rate of thrombolysis is increasing for in-hospital strokes; 30-day mortality outcomes are still much worse.

Background Hypertension is a stroke risk factor with known disparities in prevalence and management between Black and White patients. We sought to identify if racial differences in presenting blood pressure (BP) during acute ischemic stroke exist. Methods and Results Adults with acute ischemic stroke presenting to an emergency department within 24 hours of last known normal during study epochs 2005, 2010, and 2015 within the Greater Cincinnati/Northern Kentucky Stroke Study were included. Demographics, histories, arrival BP, National Institutes of Health Stroke Scale score, and time from last known normal were collected. Multivariable linear regression was used to determine differences in mean BP between Black and White patients, adjusting for age, sex, National Institutes of Health Stroke Scale score, history of hypertension, hyperlipidemia, smoking, stroke, body mass index, and study epoch. Of 4048 patients, 853 Black and 3195 White patients were included. In adjusted analysis, Black patients had higher presenting systolic BP (161 mm Hg [95% CI, 159–164] versus 158 mm Hg [95% CI, 157–159], P <0.01), diastolic BP (86 mm Hg [95% CI, 85–88] versus 83 mm Hg [95% CI, 82–84], P <0.01), and mean arterial pressure (111 mm Hg [95% CI, 110–113] versus 108 mm Hg [95% CI, 107–109], P <0.01) compared with White patients. In adjusted subanalysis of patients <4.5 hours from last known normal, diastolic BP (88 mm Hg [95% CI, 86–90] versus 83 mm Hg [95% CI, 82–84], P <0.01) and mean arterial pressure (112 mm Hg [95% CI, 110–114] versus 108 mm Hg [95% CI, 107–109], P <0.01) were also higher in Black patients. Conclusions This population‐based study suggests differences in presenting BP between Black and White patients during acute ischemic stroke. Further study is needed to determine whether these differences influence clinical decision‐making, outcome, or clinical trial eligibility.